Key Takeaways

• Frequent copays under PSHB in 2025 can quietly accumulate and outpace your expectations, especially if you need multiple visits or treatments in a short time.

• A plan that appears affordable based on premiums alone may become expensive when you factor in repeat copayments for specialists, therapy, urgent care, and diagnostics.

The Misleading Comfort of a Low Premium

When you’re reviewing Postal Service Health Benefits (PSHB) plans, it’s easy to focus on the monthly premium. A lower premium seems like a win, especially if you’re relatively healthy. But in 2025, many PSHB enrollees are discovering that frequent copays can turn what seemed like an affordable plan into an expensive one.

Premiums only tell part of the story. What truly affects your wallet is how often you’re using your benefits—and how much you’re paying each time you do.

Understanding How Copays Work in PSHB Plans

A copay is a fixed amount you pay for a specific service. It’s separate from coinsurance, which is a percentage of the cost. Most PSHB plans clearly state the copay amounts:

• Primary care visits

• Specialist visits

• Urgent care

• Emergency room care

• Diagnostic imaging (e.g., MRI, CT scan)

• Physical therapy, mental health visits, or other ongoing care

But while the individual copay amounts might seem reasonable—say, $25 for primary care or $50 for a specialist—things change when you need multiple services in a month.

1. Specialist Visits Stack Up Quickly

In 2025, more enrollees are seeking specialty care as they age or manage chronic conditions. You may need to see a cardiologist, endocrinologist, orthopedic surgeon, or dermatologist regularly. If each visit comes with a $50–$60 copay and you have three or four specialists, that adds up quickly.

Even if each visit is spaced out every few weeks, the cumulative out-of-pocket cost from copays alone can challenge your budget. And that doesn’t include any lab work, tests, or follow-ups tied to those visits.

2. Rehabilitative or Mental Health Services Create Repeat Charges

Ongoing therapies are a major driver of frequent copays. Whether it’s physical therapy, occupational therapy, or mental health counseling, many PSHB plans charge a copay for every session.

If you’re recovering from surgery and need therapy twice a week, even a $30 copay turns into $240 a month. The same applies to weekly counseling or substance use treatment. These services are essential—but their cost adds up when you’re paying each time.

3. Urgent Care and Diagnostic Testing Are Often Overlooked

Urgent care visits and diagnostics are unpredictable. You might go months without needing them, then suddenly require two or three in one month. Each urgent care visit might cost $50–$75, and imaging or lab services often carry their own separate copays.

For example:

• A chest X-ray could be one copay.

• A follow-up ultrasound could be another.

• A diagnostic blood panel might carry an additional charge.

If all these occur in the same week, that “affordable” plan starts looking a lot more expensive.

4. Preventive Services May Be Covered—But Related Visits Aren’t Always

Most PSHB plans follow ACA rules for preventive services, which are typically covered without copays. But if your screening leads to additional testing, follow-ups, or treatment, those visits do carry copays.

This is a common trap: you go in for a free screening, discover something that needs further attention, and suddenly find yourself facing multiple copays in a short window.

5. Children and Family Plans Magnify the Frequency

If you’re enrolled in a Self Plus One or Self and Family plan, multiply every copay by how many family members are using care. Children typically need frequent visits for vaccinations, injuries, or seasonal illnesses.

Each:

• Pediatric visit

• Trip to urgent care

• Dental or vision-related appointment (depending on how your plan classifies it)

…comes with its own copay. This quickly compounds, especially in households with multiple dependents.

6. High Utilizers of Care Hit the Budget Wall Faster

In 2025, a significant number of PSHB enrollees are managing chronic health issues such as diabetes, high blood pressure, arthritis, or heart disease. These conditions often require:

• Regular doctor appointments

• Medication management visits

• Monitoring labs or scans

• Counseling or education sessions

Each one of those is typically a separate charge. Over a quarter or two, the number of copays can exceed expectations—and strain monthly budgets.

When Cost Awareness Becomes a Necessity

If you’re not tracking how often you use your benefits, you could be underestimating how much your health care is truly costing you. Here’s how to stay ahead:

Compare Plans by Total Cost, Not Just Premium

Use a worksheet or planner to estimate:

• Number of expected visits per month (by type)

• Copays for each

• Multiply by 12 to get annual out-of-pocket estimates

Add this to your yearly premium total to get a more realistic comparison.

Review Explanation of Benefits (EOBs) Monthly

Don’t wait until year-end to be surprised. Your EOB shows what was billed, what your plan covered, and what you paid. Reviewing these regularly gives you a clearer picture of where your money is going.

Explore Plans With Lower Copays—Even If Premiums Are Higher

If you or a family member expect frequent care, a plan with higher premiums but lower copays may actually cost less overall. Look for plans that:

• Bundle services

• Cap visit costs

• Waive copays if combined with Medicare Part B

These options exist in many PSHB plans but may be overlooked at first glance.

Ask About Cost-Share Reductions With Medicare

If you’re a Medicare-eligible annuitant, PSHB integration with Medicare Part B can significantly reduce or eliminate certain copays. Some plans offer benefits such as:

• Waived specialist copays

• Reduced cost-sharing for outpatient services

• Prescription copay caps

It’s essential to check which plans provide these features in 2025. And if you’re unsure, a licensed agent listed on this website can walk you through your specific scenario.

PSHB Copays in 2025—What You Can Expect

While plans vary, here’s what many PSHB enrollees are seeing this year:

• Primary Care: $20–$40 per visit

• Specialist: $40–$60 per visit

• Urgent Care: $50–$75 per visit

• Emergency Room: $100–$150 per visit (separate from facility charges)

• Therapy Sessions: $25–$40 per session

These are just sample ranges. Plans differ based on whether you’re in-network, whether Medicare is involved, and whether services are bundled.

Out-of-Pocket Maximums Still Leave Room for Surprise

You might think, “Well, I’ll just hit my out-of-pocket max and then it’s all covered.” But out-of-pocket maximums don’t always include:

• Prescription drug costs (if billed under a separate pharmacy benefit)

• Services from out-of-network providers

• Non-covered services or excluded procedures

Plus, the maximum could be $7,500 for Self Only plans and $15,000 or more for families—still a sizable amount to plan around.

Small Steps That Help You Regain Control

Being proactive about copay patterns can help prevent budget strain. Consider these approaches:

• Use telehealth for minor issues (often lower or waived copays)

• Bundle appointments (e.g., labs and visits on same day)

• Ask providers about longer-term prescriptions to reduce refill visits

• Choose in-network providers and facilities to avoid inflated costs

Look at Copay Trends Before Open Season

Before the next Open Season (November–December), review your total copay spending for the year. Many plans publish their new copay structure in advance, giving you time to decide if a change is needed.

Don’t let routine services gradually drain your wallet because you underestimated their frequency.

Make Smart Choices Now to Avoid Hidden Costs Later

Even if your PSHB plan looked great on paper in January, the reality by midyear might be different. Understanding the true cost of frequent copays is essential to controlling your health care budget in 2025.

Get a head start by evaluating your year-to-date spending and plan usage. If things don’t look balanced, it may be time to consider different plan options during the next enrollment period.

And if you need personalized help breaking down plan differences, especially regarding cost-sharing and copay structures, reach out to a licensed agent listed on this website for guidance tailored to your needs.